'Highlight' Health financing for universal health coverage in the era of shocks, monitoring risks and opportunities in Sub-Saharan Africa

“强调”冲击时代全民健康覆盖的卫生筹资，监测撒哈拉以南非洲的风险和机遇

• 批准号: ES/X012921/1
• 负责人: Josephine Borghi
• 金额: $ 31.92万
• 依托单位: London School of Hygiene & Tropical Medicine
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=ES%2FX012921%2F1
• 关键词: Highlight; Health; financing; universal; health

Infectious disease outbreaks, such as COVID-19 can alter the levels and composition of health financing in low and middle income countries presenting risks and opportunities for progress towards universal health coverage (UHC). The economic consequences of COVID-19, can threaten the sustainability of domestic financing in low resource settings, and increased donor investment for pandemic preparedness could risk displacing aid away from essential services, and reduce the alignment and harmonisation of aid with country systems. However, shocks, such as COVID-19, have also been shown to create moments of opportunity which can drive positive system transformation, with a number of countries now exploring new avenues for health financing to enhance access to COVID related care. It is currently unclear, whether and how the changes brought about by COVID-19 have translated into universal health coverage (UHC) progress. The proposed research draws on the World Health Organization framework for monitoring progress towards UHC. The framework identifies three areas for monitoring: financing arrangements; intermediate outcomes of efficiency and equity; and UHC goals of service coverage and affordable health expenditures. Our research applies this framework to assess health financing at the national and subnational levels in five Sub-Saharan African countries with varied degrees of fiscal decentralisation and income levels: Tanzania, Malawi, Zambia, Senegal and Sierra Leone. Our research describes the evolution of health financing arrangements before and after COVID-19, and progress in relation to efficiency and equity of health financing and UHC goals. This research draws on routine household surveys, government and donor expenditure information systems, and global data from the World Health Organzaition and the Organisation for Economic Cooperation and Development. The research has six main objectives. First, we will describe levels of health funding raised by government, donors and households, and the level of RMNCH funding relative to infectious diseases over time. This analysis will determine whether this funding is more or less reliant on household out-of-pocket payments for health care as compared to funding from government and if this has changed with the onset of COVID-19. This analysis will also assess whether there is displacement of funds away from RMNCH post COVID-19. Second, we will examine trends in the alignment and harmonisation of aid for health, RMNCH and infectious diseases with country systems and any changes since COVID-19. Third, we will describe the levels of subnational health funding by source over time to identify temporal variation in funding across subnational units. Forth, we will measure the efficiency of health financing, the degree to which funds are optimally used in terms of UHC goals, without wastage. We will examine why some subnational units are more efficient than others, and whether income, the number of health facilities per 1000 population and sources of health funding matter. Fifth, we will assess financing equity: the distribution of government and donor health funding and household out of pocket payment contributions across subnational units in relation to the income level and burden of neonatal and under five mortality. Sixth, we will explore the relationship between efficiency and UHC goals, by assessing the level of association between these variables across subnational units. We will thus test the UHC framework, and determine whether efficiency and equity are good markers of progress towards UHC. The research will use the Countdown2030 partnership to widely disseminate findings, analytical toolkits for analysing health financing for UHC in the context of shocks; and undertake training within Sub-Saharan Africa. We will develop skills among early career researchers in our team, through training and pairing with senior researchers.

COVID-19等传染病的爆发可能会改变中低收入国家卫生筹资的水平和构成，为实现全民健康覆盖带来风险和机遇。2019冠状病毒病的经济后果可能威胁到低资源环境下国内融资的可持续性，而捐助者增加对大流行病防范的投资可能会使援助偏离基本服务，并降低援助与国家系统的一致性和协调性。然而，COVID-19等冲击也被证明会创造机会，从而推动积极的系统转型，许多国家现在正在探索卫生融资的新途径，以提高获得COVID相关护理的机会。目前尚不清楚COVID-19带来的变化是否以及如何转化为全民健康覆盖（UHC）的进展。拟议的研究借鉴了世界卫生组织监测全民健康覆盖进展的框架。该框架确定了三个监测领域：筹资安排;效率和公平的中间成果;服务覆盖面和负担得起的卫生支出的全民健康覆盖目标。我们的研究应用这个框架来评估五个撒哈拉以南非洲国家的国家和国家以下各级的卫生筹资，这些国家具有不同程度的财政分权和收入水平：坦桑尼亚，马拉维，赞比亚，塞内加尔和塞拉利昂。我们的研究描述了COVID-19前后卫生融资安排的演变，以及卫生融资的效率和公平性以及全民健康覆盖目标方面的进展。这项研究利用了常规家庭调查、政府和捐助者支出信息系统以及世界卫生组织和经济合作与发展组织的全球数据。该研究有六个主要目标。首先，我们将描述政府、捐助者和家庭筹集的卫生资金水平，以及随着时间的推移，相对于传染病的RMNCH资金水平。该分析将确定与政府资助相比，该资助是否更多或更少依赖家庭自付医疗费用，以及这种情况是否随着COVID-19的爆发而发生变化。该分析亦将评估COVID-19后是否有资金从RMNCH转移。第二，我们将审查卫生、RMNCH和传染病援助与国家系统的一致性和协调性趋势，以及自COVID-19以来的任何变化。第三，我们将描述不同来源的国家以下各级卫生资金水平，以确定国家以下各级单位资金的时间变化。第四，我们将衡量卫生筹资的效率，即资金在无浪费的情况下最佳地用于全民健康覆盖目标的程度。我们将研究为什么一些国家以下单位比其他单位更有效率，以及收入，每1000人的卫生设施数量和卫生资金来源是否重要。第五，我们将评估融资公平性：政府和捐助者卫生资金以及家庭自付捐款在国家以下各级单位之间的分配情况，与收入水平和新生儿和五岁以下儿童死亡率负担的关系。第六，我们将探讨效率和全民健康覆盖目标之间的关系，通过评估这些变量之间的关联水平在国家以下单位。因此，我们将测试UHC框架，并确定效率和公平是否是UHC进展的良好标志。该研究将利用Countdown 2030伙伴关系广泛传播研究结果，分析工具包，用于分析冲击背景下的全民健康覆盖卫生筹资;并在撒哈拉以南非洲地区开展培训。我们将通过培训和与高级研究人员配对，在我们的团队中培养早期职业研究人员的技能。